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Intraoperative factors and anastomotic leak

A number of factors can influence the safety of anastomosis following ileocolic resection, with evidence from published literature.

These include:

  • Intraoperative contamination
  • Duration of surgery > 4 hours
  • Use of inotropic support (increasing with number of agents and time support required)
  • Blood loss > 100mls
  • Blood transfusion (with an increased risk with even a single unit transfusion)

This highlights the importance of revisiting the decision for anastomosis (with or without defunctioning ileostomy) versus defunctioning stoma without anastomosis during the operation, and involving the anaesthetists and theatre team in this decision making process.

Reviewing intraoperative events forms a key part of the ESCP Safe-Anastomosis checklist.

 

The video below shows a discussion amongst surgeons of who they involve in anastomotic decision making:

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